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Don’t let under-26 son go without insurance

My son graduates from USC this year. He doesn’t have a job lined up with health insurance. Because he is under 26 years old, we can put him back on our employer plan, but it’s almost $400 per month! I want to help our son out, but that’s ridiculous. He’s healthy, so I am considering maybe just not insuring him until he can get his own through work.

It’s never a good idea to forgo health insurance if you can avoid it, even for the young and healthy: An accident or unexpected illness can cost you dearly. “It doesn’t take much to rack up a lot of money in hospital bills. Even one trip to the ER can cost hundreds or thousands of dollars,” says Aaron Smith, executive director of Young Invincibles, a Washington, D.C.-based nonprofit that advocates for young adults.

Also consider: If you claim your son as a dependent on your tax return, you may be on the hook for his medical bills, warns Anthony Wright, executive director of the healthcare advocacy coalition Health Access California. “I’ve seen hospitals go after parents,” he says.

There’s another risk in going without insurance. Federal law guarantees your son a policy from private insurers as long as he can show he’s had continuous medical coverage. A gap would make it difficult for him to buy insurance on his own if he develops an illness or is injured while uninsured, at least for now. When the health reform law takes full effect in 2014, insurers will no longer be able to deny coverage to people with preexisting health conditions.

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If your employer-based insurance is too expensive, your best bet is the private insurance market. Since your son is healthy, there’s a good chance he’ll find a cheaper plan than the one offered by your employer. Just be aware that less expensive plans tend to have higher deductibles and are more bare-bones in their benefit offerings. “Let the buyer beware with regard to buying insurance on the individual market,” Wright advises.

Be sure to pay close attention to all the fine print to get a true sense of how much a plan will cost. Look beyond the monthly premium and check on annual deductibles (the amount you pay before insurance coverage kicks in), co-pays (the fixed dollar amount you pay for medical services like a doctor visit or prescriptions), coinsurance (the percentage of medical expenses you’re responsible for) and the cost of prescription drugs.

Check for plans and prices in your area at the federal government website Healthcare.gov. It’s also a good idea to consult with someone knowledgeable about the insurance market in your area. You can find agents who specialize in health insurance on the National Assn. of Health Underwriters website, nahu.org (click “search” on the home page menu to find member agents). Another option is to compare and purchase insurance at any number of online brokerages, including ehealthinsurance.com, insuremonkey.com, healthcompare.com and healthplanone.com.

For information about the health insurance options available to college grads, check out the Young Invincibles’ tool kit: Go to https://www.younginvincibles.org and click on “tools” on the menu.

My husband and I are both covered under my employer’s health insurance. He turns 65 this year and will be eligible for Medicare. Should he sign up for Medicare, and how will that coverage affect his private insurance?

A number of factors will play into whether your husband should sign up for Medicare right now. And you’ll have to carefully consider various pieces of Medicare — Parts A, B and D — and how each applies to your situation. Here’s how it breaks down.

Regardless of anything else, your husband may as well sign up for Medicare Part A, which helps to pay for inpatient hospital care, says Vicki Gottlich, senior policy attorney for the Center for Medicare Advocacy, a nonprofit education and advocacy organization. “There’s no cost to it,” she says — and in the event that he’s hospitalized, Medicare might cover services that your employer-sponsored insurance does not.

Medicare Part B, on the other hand, which covers outpatient care, will cost you a monthly premium. If your employer has 20 or more employees, you can delay signing up without incurring a penalty. Many working seniors choose not to pay for Medicare Part B (as well as Part D, for prescription drugs) coverage because it duplicates their employer’s plan.

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It pays to do a little math before you decide what to do: Your best move will depend on how much you’re spending on your husband’s outpatient healthcare and whether your current costs are higher than the Part B premium would be.

Some numbers to consider: The 2011 standard monthly premium for Medicare Part B is $115.40, assuming that you and your husband together make $170,000 or less annually. (If your joint income exceeds $170,000, you’ll pay more.) It also matters whether the premium is withheld from your Social Security check; see details at the Center for Medicare Advocacy’s website at https://www.medicareadvocacy.org (click on “Info by Topic” to find Medicare Part B information).

If your husband is currently shelling out $115 or more each month on co-pays and deductibles for outpatient care, it may make sense for him to sign up now so that Medicare Part B can help to cover some of the costs your employer’s plan does not. If he isn’t, hold off on Part B, Gottlich advises. Just be aware that once you retire and your employer coverage ends, your husband will have eight months to sign up for Medicare Part B or he’ll incur a late penalty that will stick with him for life.

Finally, there’s Part D drug coverage. Here, Gottlich says, your choice should be based on which plan —Medicare or your employer’s — will give your husband better coverage. If your employer’s coverage is comparable to Medicare’s (and therefore considered “creditable coverage”), he can wait until his drug coverage from your plan lapses, at which time he has a 63-day window within which to enroll without facing a penalty.

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As you can see, it’s complicated (we didn’t even touch on Medicare Advantage plans). That’s why it’s always a good idea to seek personalized assistance when enrolling in Medicare. In California, you can take advantage of California’s Health Insurance Counseling and Advocacy Program (HICAP) either through its website (www.cahealthadvocates.org/HICAP) or by calling (800) 434-0222.

In addition, State Health Insurance Assistance Programs (SHIP) offer free personalized Medicare counseling throughout the country. To find the SHIP near you, visit the Medicare Helpful Contacts page on Medicare.gov or call (800) MEDICARE, or (800) 633-4227.

Medicare.gov can answer many questions you might have. The Medicare Rights Center (medicareinteractive.org) is another great resource.

Good luck!

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Zamosky has been writing about how to access and pay for healthcare for more than 10 years.

Got a healthcare dilemma? Email health411@latimes.com or write to Health 411, Los Angeles Times Health, 202 W. 1st St., Los Angeles, CA 90012.


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